22. European Stroke Conference 574 Acute stroke: emergency management, stroke units and complications STROKE ASSOCIATED RESPIRATORY INFECTION S.M. Voyaki1, S. Hini2, S. Siassiakou3, A. Kanelou4, E. Alexaki5, P. Tsiodra6, S. Pagoni7 GENERAL HOSPITAL OF ATHENS, ATHENS, GREECE1, GENERAL HOSPITAL OF ATH-ENS, ATHENS, 2, GENERAL HOSPITAL OF ATHENS, , 3, GENERAL HOSPITAL OF ATHENS, ATHENS, 4, GENERAL HOSPITAL OF ATHENS, ATHENS, 5, GENERAL HOSPITAL OF ATH-ENS, , 6, GENERAL HOSPITAL OF ATHENS, ATHENS7 Background : Respiratory infection is a frequent complication of acute ischemic stroke, and main cause of morbidity and mortality. Purpose of this study is to examine the clinical characteristics of stroke associated respiratory infections. Methods : 1183 patients (618M/565F) with acute stroke (aged 60-101), were admitted in our Hospital. Age, gender, history of stroke, the severity of stroke on admission according to known neurological scales, stroke subtype (lacunar brain infarction, ath-erothrombotic brain infarction, cardioembolic brain infarction, and others), aspiration, naso-gastric tube feeding, vascular risk factors, the length of hospital stay and outcome of patients were noted. We compared them between patients with and without respiratory infections. Results : 42% had ischaemic infarct of large arteries, 12% intracerebral haemorrhage, 8% lacunar infarct, 24% cardi-oembolic and 14% were unclassified. 140 stroke patients (11.8%) developed respiratory infections. Cardioembolic stroke patients were more frequently developed respiratory infections (P=0.003) compared with other stroke subtypes. The independent risk factors for respiratory infections by multiple logistic regression model were the aspiration (OR, 5.513 ; 95% CI, 1.793-16.946) and the severity of stroke on admission (OR, 1.090 ; 95% CI, 1.034-1.150). Mortality of patients with re-spiratory infections was as high as 30%, After adjustment for age, sex, the severity of stroke and other cardiovascular risk factors, respiratory infection was one of the independent risk factors of poor stroke outcome (OR, 5.838 ; 95% CI, 1.792-19.018). Conclusions : Aspiration and the severi-ty of stroke independently predict the development of respiratory infections complicating ischemic stroke. Respiratory infections may make worse their stroke outcome. A measure to prevent aspira-tion pneumonia needs to be taken for patients suffering from severe ischemic stroke. 648 © 2013 S. Karger AG, Basel Scientific Programme 575 Acute stroke: emergency management, stroke units and complications Resource use and quality of care in an urban stroke unit J. K. Boyle1, H. Casey2, C. L. Doyle3, M. R. Walters4 University of Glasgow, School of Medicine, Glasgow, UNITED KINGDOM1, University of Glasgow, School of Medicine, Glasgow, UNITED KINGDOM2, University of Glasgow, School of Medicine, Glasgow, UNITED KINGDOM3, Acute Stroke Unit, Western Infirmary, Glasgow, UNIT-ED KINGDOM4 Background Stroke is the third most common cause of mortality and the most common cause of disability world-wide. It has been consistently shown that patients placed on acute stroke units (ASU) have signifi-cantly better outcome measures. We attempted to gain a better understanding of the benefits of the stroke unit by following stroke patients within and out with ASU, Western Infirmary Glasgow. Fur-thermore, the efficiency of bed management within ASU was assessed. Methods Over a 3 week period we investigated all patients under the care of the stroke team. There were 3 groups: stroke patients within ASU; medical boarders in ASU; and stroke patients boarded out with ASU. 29 stroke patients in ASU and 18 stroke patients boarded out were compared based on a range of parameters. At 11am on each weekday a snapshot view of all three groups was performed in order to assess bed management. Results Stroke patients within ASU were shown to have significantly less time to CT brain (p<0.0001), shorter time to therapist review (p=0.0447), more blood pressure (p=0.0243) and Glasgow Coma Score (p=0.0033) measurements in their first 24 hours of admission than stroke patients boarded out with ASU. Age, sex, DEPCAT score and time to consultant review were found to be not significant between the two groups of stroke patients. Conclusion Better outcome measures in ASU could be attributed to the differences between the groups of stroke patients. Prompt therapist input and frequent nursing observations have long been considered to be imperative in the success of ASU; our findings wholly support this and highlight the importance of the multidisciplinary approach. The snapshot data revealed that bed capacity on ASU was sufficient for the number of stroke pa-tients. However capacity was not being utilised efficiently as non-stroke medical boarders occupied beds consistently whilst stroke patients were boarded out to other wards.
Karger_ESC London_2013
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